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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED U Date: <2``�1 �1 Permit Number: ' �. � ~ "err; , RECEIVED JUN 03 2017 - - Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: PR�QPOSED IN!PR®1/EMENT OCATIO',N: Address: ?,'V'S o Legal Description: r10'6A - 00 o S o o O - Property Tax ID#: Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DEASCRIPTION OF WORK: c-e We A,-- Qy`rk'Q Ly tJ %3 1­11 � SCe%I V5 l S.�o© K� 2•o cil^N toC o z Z 'zoo b y iC ", 5 E E a l L{ I •a oa 11"' CONSTRUCTION INFORMATION: Additional work to be performed under this permit-check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ Utilities: —Sewer —Septic Building Height: OWNER/LE--S�SEE: CONTRACTOR: me ` �'�'/kv�t\'cE ' O'�.a €..1\�R ,� Name N �c,N Na >. ;.. Address::`.�d�1'3.0 ,,.moo +gm, Qo�,�� {�c� Compariy: :. -vol:`.. ;lc l� .SEvv�cES . City: P0C"c SR\-N'C State:k Address: 91)4AJ Zip Code: '341(IM, Fax: City: State:�l Phone No. Zip Code: '3`l�ts % Fax: E-Mail: PhoneNo(gs` ) Gz3b- yaS`I Fill in fee simple Title Holder on next page(if different E-Mail Lvc5�oki v.04 r10@,Wo`�w.eS.o��eon from the Owner listed above) State or County License cAc- *- %S%%kwo If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SIJPPLENIENTP I C®NSl"Rll I©N Ll!EN 1�4W I1IV'-O�RM/�TIQt DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of a permit. St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply. In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects,-perform the work in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments. The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before commencing work or recording our Notice of Commencement. �/e Signa ure of Ow essee/Contractor as Agent for Owner Si n ture of Contfa or/Lic rise Holder STATE OF FLORIDA STATE OF FLO IDA COUNTY OF ��, L.ii('ue COUNTY OF S . L-UCLU The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this nday of ,uY12, 20JI by this�day of �C)ne. , 20_L—1 by Mourl(6 Inn"I'P11,00 -a_ ) lei (Name of person acknowledging) (Name of person acknowle ing) (Signature of Notary Public-State of Florida ) Signature of Notary Public-State of Florida ) Personally Known OR Produced Identification Personally Known X_ OR Produced Identification Type of Identification Type of Identification DANIELLE EILEEN CUSICK DANIELLE EILEEN CUSICK Produced A.i Produced = =' MYC ISSION 0 FFS42725 e MY COMMISSION 0 FF942725 EXP1R S mbar 10,2019 Commission No. EXPIRt�mber 10,2019 Commission No. '"''.33 oom (407)398-0.53 -cam REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 7 4